Disability index in a randomized controlled trial of emergency sclerotherapy versus portacaval shunt for bleeding varices in cirrhosis

Marshall J. Orloff, Jon I. Isenberg, Henry O. Wheeler, Kevin S. Haynes, Horacio Jinich-Brook, Roderick Rapier, Florin Vaida, Robert J. Hye, Susan L. Orloff

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Disability has not been studied after emergency treatment of bleeding esophageal varices (BEV). We created a disability index (DI) in a randomized controlled trial comparing emergency endoscopic therapy (EST) versus emergency portacaval shunt (EPCS). Methods: There were 211 unselected, consecutive patients with cirrhosis and acute BEV who were randomized to EST (n = 106) or EPCS (n = 105). Diagnostic work-up and treatment were performed within 8 hours. Ninety-six percent underwent more than 10 years follow-up evaluation. Disability was measured by assessing 9 factors to create a DI. Results: Ten-year survival was 8% after EST versus 51% after EPCS (P <.001). EPCS had a significantly better DI. The EST and EPCS values were as follows: liver function improvement: not applicable and ++; worsening liver function, ++ and not applicable; portal-systemic encephalopathy (PSE) incidence, 36 and 15; PSE episodes, 179 and 94; packed red blood cell units, 1,005 and 320; hospital readmissions, 387 and 292; and number of readmission days, 9.6 and 4.7. All of the P values were less than.001. Conclusions: EPCS resulted in a markedly better DI than EST, a significantly higher survival rate, better control of bleeding, and a lower incidence of PSE. EPCS is an effective first-line emergency treatment of BEV.

Original languageEnglish (US)
Pages (from-to)157-166
Number of pages10
JournalAmerican journal of surgery
Volume204
Issue number2
DOIs
StatePublished - Aug 2012

Keywords

  • Bleeding varices
  • Endoscopic sclerotherapy
  • Portacaval shunt
  • Quality of life

ASJC Scopus subject areas

  • Surgery

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